Medicare Physicians

News & Analysis as of

Representatives Introduce Medicare Patient Access to Hospice Act

On March 1, 2017, Representatives Lynn Jenkins (R-KS-2) and Mike Thompson (D-CA-5) introduced the Medicare Patient Access to Hospice Act, H.R. 1284, to the 115th Congress. The bill was referred to the Committee on Ways and...more

Direct Primary Care: Getting Calls from Patients While Avoiding Calls from Law Enforcement

For providers interested in simplifying the provider-patient relationship, one option is direct primary care. Ironically, though, simplification can be complicated, particularly when the government is involved. One of the...more

Medicare Advisors Debate Part B Drug Payment Reforms

Last week, the Medicare Payment Advisory Commission (the “Commission”) debated a package of policy reforms that would change the way Medicare reimburses physicians for Medicare Part B drugs. In the midst of calls to lower...more

Recent Changes to Medicare “Incident To” Billing Rules

Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more

New Medicare Fraud Defense: “My Mom Made Me Do It!”

Charged with 33 counts of Medicare fraud netting some $45 million in false claims, Richard Tinimbang invoked a novel defense: “My mom made me do it!” That, according to Law360, is the gist of the opening statement of...more

New Medicare Conditional Payment Case: Federal Court Requires CMS To Perform Surgery On Its Primary Plan Reimbursement Demands

Doctors often treat Medicare beneficiaries for accident related injuries (for which a “primary” auto or workers’ compensation carrier must reimburse Medicare) and unrelated maladies at the same visit. Billing for the visit...more

Health Care Fraud and Abuse in the Middle District of Florida in 2016 - a Year in Review

The United States Attorney’s Office (USAO) for the Middle District of Florida (USAO-MDFL) prosecuted several civil health care fraud matters in 2016 and issued related press releases. A review of the USAO-MDFL’s criminal and...more

Fraud and Abuse Investigations Should be Taken Very Seriously

According to the United States Government, fraud and abuse recovery has an excellent return for each investment dollar spent. According to the Health Care Fraud and Abuse Control (HCFAC) Program Report,released by the...more

2016 Round-Up: Key Decisions Affecting Connecticut Health Care Providers

Connecticut state and federal courts faced a number of significant health care issues last year. We have summarized those cases that we think are particularly relevant to Connecticut hospitals, group practices and individual...more

The Brave New World of Physician Medicare Payment: MACRA Makes Sweeping Changes

On November 14, 2016, CMS published its final rule implementing the physician payment provisions of the Medicare Access and CHIP Reauthorization Act (“MACRA”). The rule became effective January 1, 2017. Data collection from...more

Potential Implications to the ACA Under the Incoming Republican Administration – Part II: Physicians

In contemplating the ways in which physicians may be affected by the possible repeal of the Affordable Care Act (ACA)—and certain features of any legislation that may replace it—a good place to start is with the person...more

The MACRA Final Rule: In Search of the “Goldilocks” Model

The Medicare Access and CHIP Reauthorization Act (“MACRA”) Final Rule published late last year implements CMS’ new payment approach for physicians and other Medicare Part B eligible clinicians under the Merit-Based Incentive...more

Final Rule Implements Quality Payment Program under MACRA

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

2016 Health Care Year in Review

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

The MACRA Final Rule: 10 Things You Need to Know

The Centers of Medicare and Medicaid Services (CMS) released the much-anticipated Medicare Access and CHIP Reauthorization Act (MACRA) final rule this month. The rule makes extensive changes to traditional Medicare Part B...more

Health Law Insights: November Newsletter

ALERT: "No Contract" Disclaimer in Employee Handbook Upheld by Illinois CourtAuthor: Employee handbooks have long been a trap for the unwary employer that desires merely to establish a set of rules and policies without...more

Could Possible Healthcare Repeal Efforts Extend to Physician Payments Under Medicare?

Now that the 2016 presidential election is over, many patients are asking whether Congress will repeal the Affordable Care Act (ACA), or parts of the legislation. Yet, many doctors are asking (or should be asking) whether...more

The Federal Government Holds Individuals Responsible for Involvement in Corporate Healthcare Fraud and Abuse

In September 2016, three corporate officers in two healthcare fraud and abuse cases settled allegations that they were personally liable for violations of federal fraud and abuse laws. These settlements come one year after...more

OIG Releases 2017 Work Plan

On November 10, 2016, the Office of Inspector General (“the OIG”) of the U.S. Department of Health and Human Services (“DHHS”) is charged with ensuring the integrity of more than 100 programs administered by DHHS, including...more

CMS Continues Efforts to Improve Patient Care, Spending, and Population Health

On November 2, 2016, the Centers for Medicare and Medicaid Services (CMS), released the 2017 Medicare Physician Fee Schedule (MPFS) final rule, which finalized a number of new policies designed to improve Medicare payment for...more

Now is the Time to Prepare for MACRA: 2017 Will Bring Major Changes to Physician Medicare Reimbursement

MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) is bi-partisan legislation that was enacted to change Medicare reimbursement from being based on the current system of volume of services provided to...more

2017 Physician Fee Schedule Includes Clarification of Space and Equipment Rental Exception Under Stark Law

The Department of Health and Human Services Center for Medicaid and Medicaid Services (“CMS”) recently finalized the Calendar Year 2017 Physician Fee Schedule (“2017 Fee Schedule”), which includes a restatement of a provision...more

CMS Reissues Stark Rules Restricting Certain Unit-based Rental Rate Arrangements and Issues Two Stark Updates

On November 15, 2016, as part of its 2017 Medicare Physician Fee Schedule update, the Center for Medicare and Medicaid Services reissued its prohibition on certain unit-based rental arrangements with referring physicians,...more

“May You Live in Interesting Times” – Some Healthcare Predictions for the Trump Administration’s First Year

The ancient Chinese curse – “May you live in interesting times” – certainly springs to mind these days. What does the election of Donald Trump mean for the healthcare industry, the Affordable Care Act and current healthcare...more

Making Sense of the MACRA Final Rule – Part 3 of 3: Merit Based Payment Incentive System (MIPS)

The Centers for Medicare & Medicaid Services (CMS) recently released its final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Among its numerous changes,...more

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